Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2007
Randomized Controlled Trial Comparative StudyComparison of the AMBU Laryngeal Mask and the LMA Classic in anaesthetised, spontaneously breathing patients.
There may be a role for single-use laryngeal mask airways with concerns about inability to adequately sterilise laryngeal mask airways to eradicate prion proteins. A single-blinded prospective randomised controlled trial was conducted to compare the clinical performance of the single-use AMBU LMA with the reuseable LMA Classic. ⋯ There was a suggestion of reduced postoperative sore throat and pharyngeal trauma for the AMBU LMA group. The AMBU LMA is a viable alternative to the LMA Classic for airway management in spontaneously breathing patients.
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Anaesth Intensive Care · Feb 2007
Ultrasound quantification of anterior soft tissue thickness fails to predict difficult laryngoscopy in obese patients.
Morbid obesity is associated with difficult laryngoscopy and intubation. In the general population, bedside indices for predicting difficult intubation (i.e. Mallampati classification, thyromental distance, sternomental distance, mouth-opening and Wilson risk score) have poor-to-moderate sensitivity (20-62%) and moderate-to-fair specificity (82-97%). ⋯ Twenty patients were classified as difficult laryngoscopy; they were older (47 +/- 9 vs 42 +/- 1 years; P = 0.048; mean +/- SD) and had less soft pretracheal tissue (20.4 +/- 3.0 vs 22.3 +/- 3.8 mm; P = 0.049) than did easy laryngoscopy patients. Multivariate regression indicated that none of the factors was an independent predictor of difficult laryngoscopy. We conclude that the thickness of pretracheal soft tissue at the level of the vocal cords is not a good predictor of difficult laryngoscopy in obese patients in the United States.
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Anaesth Intensive Care · Feb 2007
Survival and quality of life after prolonged intensive care unit stay.
There are few data on long-term outcomes in mixed groups of intensive care unit (ICU) patients with prolonged stays. We evaluated the relationship between length of stay in the ICU and long-term outcome in all patients admitted to our 31-bed department of medico-surgical intensive care over a one-year period who stayed in the department for more than 10 days (n = 189, 7% of all ICU admissions). Mortality increased with length of stay from 1 to 10 days (1 day 5%, 5 days 15%, 9 days 24%, 10 days 33%) but remained stable at about 35% for longer ICU stays. ⋯ In conclusion, in ICU patients, mortality increases with length of stay up to 10 days. Patients staying in the ICU for more than 10 days have a relatively good long-term survival. Most survivors have an acceptable quality of life.
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Anaesth Intensive Care · Feb 2007
Randomized Controlled Trial Comparative StudyRemifentanil vs. lignocaine for attenuating the haemodynamic response during rapid sequence induction using propofol: double-blind randomised clinical trial.
This study was conducted to determine whether lignocaine or remifentanil effectively attenuate the response to endotracheal intubation during rapid sequence induction. Forty-eight patients were randomly divided into three groups: Group NS (n = 16) received normal saline 0.1 ml/kg, Group L (n = 16) received lignocaine 1.5 mg/kg, and Group R (n = 16) received remifentanil 1 microg/kg. Anaesthesia was induced with propofol 2 mg/kg after glycopyrrolate 0.2 mg IV. ⋯ The maximum increase in mean arterial pressure in Group NS and Group L were 46% and 38% respectively above the baseline value one minute after intubation, whereas the mean arterial pressure in Group R increased only back to the baseline value. Heart rate in Group NS and Group L were increased by 27% and 33% above baseline value respectively one minute after intubation, while that in Group R was increased only to the baseline value. The results indicate that remifentanil 1 microg/kg, but not lignocaine 1.5 mg/kg, effectively attenuates the haemodynamic response to endotracheal intubation during rapid sequence induction using propofol.